Anesthesia and Surgical Complications Flashcards
If we can’t intubate and can’t ventilate what do you NOT do?
do not give paralytic until you can verify ability to ventilate
If you cannot ventilate the patient,
insert LMA
Conditions necessitating continued intubation:
- E
- E
- R
- H
- B
- O
- epiglottitis
- localized edema
- recurrent laryngeal nerve damage
- hemodynamic instability
- bleeding
- prolonged obtundation (anesthetics, metabolic abnormalities, neuro injury)
respiratory problems occur in________
airway obstruction
hypoventilation
hypoxemia
PACU:
Airway obstruction causes (7)
- P
- S
- L
- G
- V
- B
- P
- posterior displacement of tongue
- secretions
- laryngospasm
- glottic edema
- vomitus
- blood in airway
- external pressure on trachea
Corrective measures for air obstructions:
oxygen supplementation
jaw thrust, head tilt
NAW preferred, OAW
If obstruction still exists consider what is happening?
laryngospasm
PPV and jaw thrust
0.1 mg/kg or 10-20 mg of Succx
If PaCO2 > 45mmHg consider what is happening?
hypoventilation
A significant value for PaCO2 >____ mmHg or pH is < ______.
Primary cause for hypoventilation is:
60 mmHg
7.25
too many narcotics, patients don’t want to breath
Signs of hypoventilation:
- S
- A
- R
- T
- L
- somnolence
- airway obstruction
- slow RR
- tachypnea with shallow breathing
- labored breathing
Respiratory acidosis = (2)
Cardiac irritability = (1)
HTN, tachypnea
cardiac depression
Hypoventilatin is most common respiratory problem in PACU. true or false.
true
Signs of residual paralysis:
discoordinated movements
shallow TV
tachypnea
head lift < 5 secs
Hypoventilation due to splinting due to pain may be caused from:
from upper/lower GI Sx
abdominal distension
tight dressings
Cons of opioid antagonists to treat hypoventilation:
- pain
- HTN crisis
- pulmonary edema
- myocardial infarction/ischemia
- restlessness
- tachycardia
cardiac irritability early signs
Signs of hypoxia, PaO2 < 60 mmHg
Signs of hypoxia: late signs:
obtunded (comatose)
bradycardia
hypotension
cardiac arrest
Hypoxia due to:
- hypoventilation
- R-L shunting (blood going from r–>l of heart without being oxygenated)
- intrapulmonary shunting from decreased FRC due to GA
Intrapulmonary shunting can occur (3)
- pulmonary atelectasis caused by insufficient TV delivery
- parenchymal infiltrates aka pulmonary edema
- pneumothorax aka lung collapse
Cause of intrapulmonary shunting:
- prolonged hypoventilation
- endobronchial intubation (tube in too deep)
- pulmonary aspiration
- pulmonary edema
If x-ray is white, means lung is ________.
unventilated
More than likelly fluid is built up in the lung cavity.
The carina is normally at the T_-T__ level.
T5-T7
Hypoxia treatment involves:
- 100% O2 nonrebreathing mask or ETT
- diuretics for fluid overlad
- brochodilators for bronchospasms
- PEEP/CPAP for atelectasis
Most GI complications involve:
- autonomic afferents from GI mediastinum
- vestibular CN 8
- visual//cortical stimuli
- chemoreceptor trigger zone
Most common circulatory complications in PACU:
- hypotension
- hypertension
- arrhythmias
Always consider possibility of circulatory abnormalities from respiratory disturbances. True or false?
true
Concerned with BP >= ___ baseline reduction
30%
What are causes of hypotension?
decreased venous return–hypothermic venoconstriction, hypovolemia, third spacing, post op blood loss
LV dysfunction–pneumothorax, cardiac tamponade, fluid overload, CAD, valvular disease
Excessive arterial vasodilatation–neuraxial procedures, adrenergic blockade venodilators, sepsis, allergic reaction
Hypertension primary causes: (3)
- noxious stimuli
- endotracheal intubation
- bladder distension
hypoxemia
hypercapnea
metabolic acidosis
elevated CVP
vascular volume overload
- Secondary causes of hypertension: (5)
- look at ST indicates ischemia
- respiratory disturbances, hypoxemia, hypercarbia, and acidosis
- residual effects of anesthetics
Arrhythmias
Abnormal EKG requiring treatment:
- ventricular tachycardia
- vent fib
- Sinus brady/asystole
- ST with hemodynamic instability
